--- Title: Diffusion ---

Societal Institutions

How is the perception of science affected by its alignment with different groups in society?

A lack of confidence in their major societal institutions - national government, neighbours, charities and journalists may lower a person’s trust in science and scientists.

South Africa ranks in the top 20% globally for distrust in its members of society, with the government being the least trusted of all members of society (53% of citizens distrust the government). Vietnam ranks average globally for distrust in scientists, but ranks 140/144 for trust in scientists, despite having above average levels of trust in its society.

Countries which show high distrust in society also show high distrust in scientists.

High Income

Upper Middle Income

Lower Middle Income

Low Income

Q12 In general, would you say that you trust science a lot, some, not much, or not at all?

Distrust in society: The mean of questions Q11A - Q11F answering not much or not all covering neighbours, government, journalists, doctors and nurses and NGOs.

People’s perception of science being shaped by overall trust levels raises questions about the extent to which science is seen as an objective and non-political practise.

In LMIC countries, scientists (70%) are only slightly more likely to be trusted as compared with journalists (64%) and nonprofits (60%). In HIC, scientists are generally more trusted (76%) and also much more likely to be trusted as compared with journalists (54%).

Doctors and nurses are the least distrusted of all members of society.

The trust in government question was not asked in many countries.

Globally, distrust neighbours (0.8) is more correlated to distrust in scientists than distrust in government (0.38).

CASE STUDY

SOUTH AFRICA

Of our focus countries, South Africans are amongst the most distrustful in the world (top 20%), on the measures of trust in society and science.

South Africa showed highly correlated relationships between trust in science and trust in other members of society.

In terms of absolute numbers, the most distrusted segment of society was the national government, with 53% of people stating that they had “not much, or not trust at all” in them.

Photograph: Matheo JBT on Unsplash

We took a closer look at the key milestones of distrust in South Africa where the government politicized science at the cost of public health outcomes.

19941996199720002003200620072009201220152017Science, politics and the implementation gap We took a closer look at the post-apartheid milestones of distrust in South Africa where the government politicized science & its implementation at the cost of public health. 1996 A rights-based approach to youth sexuality is announced - promotion of information and youth-friendly sexual health services, and banning the exclusion of pregnant pupils from schools. Pre 1997 Mental health care in South Africa is mainly simply isolate mentally unstable individuals. Mental health care in South Africa is mainly simply isolate mentally unstable individuals. 2000 South African President Thabo Mbeki denies causal link between HIV and AIDS. The cause, he said, was poverty, bad nourishment and general ill-health. The solution was not expensive western medicine, but the alleviation of poverty in Africa. He sets up the Presidential Advisory Panel for HIV/AIDS including several scientists who denied that HIV causes AIDS. 2000 Nomandla Yako, member of Treatment Action Campaign (TAC) HIV Medicines from Brazil.2000 The Durban Declaration is drafted in response to Mbeki’s HIV/AIDS denialism - it is signed by over 5,000 physicians and scientists, AIDS. 2003 Considerable local and international pressure resulted in the government introducing an ambitious program to provide antiretroviral therapy (ART) to all patients with HIV infection.2006 Pride Chigwedere estimates that more than 330,000 people died prematurely from HIV/AIDS between 2000 and 2005 due to the Mbeki government’s obstruction of life-saving treatment, and at least 35,000 babies were born with HIV infections that could have been prevented.CHALLENGEesidency of Thabo Mbeki. Scientists and physicians raised alarm at the human cost of HIV/AIDS denialism - , which was resulting in HIV-positive people from using proven treatments. The Durban Declaration was signed by 5000 people, including Nobel prizewinners, and directors of leading research institutions . “AIDS literacy” was disseminated by activists in public spaces and institutions. Yet - the cost of Mbeki’s stance is believed to have resulted in more than 330,000 deathsHow might scientists ensure that their voices are heard during a politicised health crises? 1997 South Africa embarks on a programme to deinstitutionalize mental health care and integrate it into Primary Health Care (PHC).2007 A study by the WHO 56% of mental health care still takes place in an institutionalised setting. ent negative experiences on the day before the survey. If we use this as a in 2009 still holds true. 2009 common mental disorders concludes nearly one in three South Africans will many low- and middle-income countries. 2009 common mental disorders concludes nearly one in three South Africans will many low - and middle-income countries.Formal demise of apartheid Negligence & tragedy in translating MH policy into practise Mbeki’s stance casts a long shadow2006 Scientists, activists sue South Africa’s Matthias Rath who ran illegal medical trials for his multivitamins, which he markets to ‘poisonous’ antiretroviral drugs.Global AverageSouth AfricaWestern CapeNorthern CapeWorry39%Stress35%Physical Pain31%Sadness24%22%22%2012 South Africa adopts a new National Mental Health Policy Framework and Action decentralized integrated primary mental health services.2015 The Gauteng Department of Health announces it will end its contractual relationship with Life Healthcare Esidimeni Hospital - a facility providing inpatient care, treatment and rehabilitation for people with chronic psychiatric disorders, and severe intellectual disability - and 2015 on shoestring budgets will be responsible for supporting 2000 patients who will be discharged from Life Esidimeni. The plan is titled the Gauteng Mental Health Marathon Project. 2015 Corpses of psychiatric patients are found with head injuries and unexplained bruises. It emerges that in starvation, dehydration and cold - following their transfer from institutional care to community-based NGOs. The whereabouts of another 44 remain unknown. CHALLENGEMonitoring and contesting real-world implementation of science policiesSouth Africa has been taking steps towards strengthening mental health care in the last 20 years. These include reforming the Mental Health Care Act 2002 and developing a National Mental Health Policy Framework and Strategic Plan 2013–2020. However, these reforms have not delivered on their objectives of decentralization and destigmatising of mental health services. A botched and rushed implementation resulted in a tragedy - raising important ethical, moral, political, legal, governance, accountability, and clinical issues. How might science contribute to closing the implementation gap and contesting poor execution in the real world?

CASE STUDY

VIETNAM

Low distrust ≠ Trust in Vietnam

Trust is asymmetric in Vietnam. It shows low levels of distrust in society but higher levels of distrust in science and scientists. From a global level, this level of distrust in science and scientists is average, but intriguingly, Vietnam is one of the lowest in the world for saying they trust science and scientists. They have very large proportions replying “don’t know”.

Photograph: Matheo JBT on Unsplash

Key Takeway

Socio-political events and societal actors play an important role in the public perception of trust in science. Some of these events are well known - others less so. Understanding the existing landscape and contextualising interventions is necessary to ensure uptake and adoption.

Opportunity

How might science better understand, record and account for contextual complexity?

The Lens of Societal institutions

How much or how little are different societal groups in a country trusted, and does this affect trust in scientists?

Negative experiences with the state, non-profits, journalists, neighbours, doctors and nurses may color the perception of science and scientists.

Use this lens to understand how much or how little are the different societal groups in a country trusted, and whether this affects trust in scientists.